MEDICARE: DR. DOMINIC J TOTANI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	3224	OK
2	207QA0505X	Adult Medicine Physician	OS11746	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1396734646	OTHER	FL	NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	OS11746	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1396734646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINIC J TOTANI D.O.

Provider Business Mailing Address
First Line	:	9960 S OCEAN DR
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-2455
Country	:	US
Telephone Number	:	918-688-6628
Fax Number	:	561-828-3372

Provider Business Practice Location Address
First Line	:	8942 S US HIGHWAY 1
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-3403
Country	:	US
Telephone Number	:	772-398-1305
Fax Number	:	772-398-1307

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	03/07/2023

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